Nurse used excessive force on patient with learning disability

By agency reporter

December 15, 2018

The Nursing and Midwifery Council (NMC) has found that Nurse Maxwell Nyamukapa’s fitness to practice is impaired after he used excessive force against Ben, a vulnerable patient with a learning disability.

Ben was an inpatient at Winterbourne View from 2009 to 2011, a specialist hospital for adults with learning disabilities and mental health needs. Ben was a vulnerable young adult with autism and a severe learning disability. His placement at Winterbourne View was intended to meet his needs in a safe environment. Nurse Maxwell Nyamukapa, a qualified Registered Learning Disabilities Nurse, was a member of Ben’s care team there.

On 20 August 2009, Nurse Nyamukapa punched or hit Ben in the face, resulting in a serious dental injury to Ben, including two dislodged teeth and a fracture to part of his jaw. Despite dental treatment, Ben lost his two upper teeth and now uses dentures.

In the immediate aftermath of the incident, a number of different safeguarding meetings and internal investigations at Winterbourne View were commenced, and Nurse Maxwell was interviewed by the police, but no further action was taken. A BBC Panorama documentary aired on 31 May 2011 exposing large scale mistreatment and abuse of residents by staff members at Winterbourne View and it was subsequently closed down.

For many years, Ben’s family have tried to have Nurse Nyamukapa’s conduct investigated. An initial NMC hearing took place in December 2017 and concluded that that Nurse Nyamukapa had punched Ben in the face and fractured his jaw, but that there was insufficient evidence to show that this amounted to excessive force.

Ben’s family appealed via the Professional Standards Board for the NMC to re-investigate the case. Following a second hearing in December 2018, the NMC determined that Nurse Nyamukapa had punched Ben in the face and used excessive force.The NMC heard evidence from dental experts who confirmed that the severity of his injuries was consistent with a blow to the face with a hockey stick, or the impact of a steering wheel during a road traffic accident.

The NMC Panel found that, by virtue of his condition, Ben could sometimes be challenging, but that as a registered professional working within a specialist unit, Nurse Nyamukapa was expected to be able to manage and respond to challenging behaviour professionally and appropriately. The Panel agreed that punching a patient would never be appropriate.

When handing down its sanction against Nurse Nyamukapa, the NMC highlighted the responsibility for nurses to at all times do no harm and to act as advocates for their patients, particularly in environments where cultures of abuse or neglect are found.

Ben’s family have welcomed the NMC’s decision with relief. His sister said: "This case followed an incident that should simply never have happened, the impact of which will likely be felt for the rest of Ben’s life. Whilst we can take no joy in an outcome that takes the livelihood of a practising professional, we welcome the justice afforded to Ben, and the protection that this decision provides for other vulnerable patients now and in the future. We hope that this sends the necessary message to professionals who abuse their positions of power, that the voices of vulnerable people can and will be heard, and that there can be no excuses for abuse and neglect in our health or social care systems, or in our society."

Alison Millar, Head of the Abuse Team at Leigh Day, who represented Ben in a civil claim relating to abuse at Winterbourne View, said: ‘We, and Ben’s family, are very relieved that the NMC has finally believed our client’s account and ensured that Nurse Maxwell is no longer able to work with vulnerable patients. His actions constituted a horrendous assault on a vulnerable adult who should have been cared for with dignity and respect. This NMC’s decision is an important reminder of the need for adults with learning disabilities to be listened to and properly supported through regulatory investigations, so that poor care and abuse can be stamped out.

“For nine years, our client had consistently maintained that he had been punched by Nurse Nyamukapa: he had told this to his treating dentist, during his police interview, and repeatedly to his mother. This case demonstrates the real need to listen to and take seriously the evidence of service users with learning disabilities, so as to protect other vulnerable adults in the future.

“We are pleased that the NMC has used this decision to send a strong message to nurses that it is even more important for them to challenge and prevent abuse in institutions like Winterbourne View where neglect and mistreatment of vulnerable adults is embedded within the workplace.”

Jan Tregelles, Chief Executive of Royal Mencap Society, said: “It is unacceptable for anyone to be treated in this way and it is only due to the determination of Ben’s family that there has now been long overdue recognition of what happened. Winterbourne View shone a light on the widespread misuse of assessment and treatment units, with people like Ben staying for years in settings which are only meant for short periods. The government’s Transforming Care programme was meant to deliver the high quality local community support needed to significantly reduce in-patient bed numbers. But, despite a commitment from the Health Secretary to deal with this problem, we have not seen nearly enough progress to give us confidence that the right support will be available to all who need it.”

Vivien Cooper, Chief Executive of the Challenging Behaviour Foundation, said: “Ben’s case is shocking on a range of levels – that a trained nurse could inflict such a violent assault on a patient, and that 'the system' to protect him and hold people to account should be so slow and difficult to navigate. People with a learning disability and behaviour that challenges continue to experience unacceptable treatment in in-patient units, where they are vulnerable to assault, overmedication, seclusion and restraint, and experience trauma with long term consequences. Concerns raised by families, advocates and whistle-blowers must be taken seriously and be swiftly acted on.”

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